Boston Sojourn Enrollment Form (March 25-April 1, 2022)

Boston Sojourn Enrollment Form (March 25 - April 1, 2022)

Please fill out completely.
Participant Name (name you prefer to be called, have on your name tag, etc) *

First Name Last Name
Participant Legal Name (For Flights) *

First Name Last Name
What type of participant are you? *

Student Alumni Teacher/Educator Parent Adult (non parent of participant) Other
Birthdate (mm/dd/yyyy) *

Month Day Year
Date
Gender Identification - Please type M or F or how your prefer to self-describe as: *
Participant Email *
example@example.com
Participant Phone Number *
Please enter a valid phone number.
Primary Parent/Guardian Name (If participant is a high school student)
Primary Parent/Guardian Email (If participant is a high school student)
example@example.com
Primary Parent/Guardian Cell Phone Number (If participant is a high school student)
Please enter a valid phone number.
Secondary Parent/Guardian Name (If participant is a high school student)

First Name Last Name
Secondary Parent/Guardian Email (If participant is a high school student)
example@example.com
Secondary Parent/Guardian Cell Phone Number (If participant is a high school student)
Please enter a valid phone number.
Complete Home Mailing Address (Number, Street, Apt #, City, Zip)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Waivers

In the event of a medical emergency I understand that Sojourn will make every effort to contact me as the parent / guardian. Absent the ability to contact me, the parent / guardian, I hereby give permission to the medical personnel, selected by Sojourn to obtain appropriate medical assistance for the child named below.

Permission is granted to include photographs and videos taken of your child in marketing and informational material produced by Sojourn to the Past. Sojourn to the Past also has the right to reproduce in whole or in part essays or after writings by your student during the journey.

Your signature below acknowledges that you have read and agree to the cancellation policy.
Participant Signature (Is only required if participant is not currently enrolled in high school and is 18 or older. We only need a parent signature for high school students because parent is the legal guardian.)

Clear
Date

Month Day Year
Date
Primary Guardian/Parent Signature (Required if participant is a high school student)

Clear
Date

Month Day Year
Date
Should be Empty:

Boston Sojourn Enrollment Form (March 25 - April 1, 2022)